Apart from absense for religious observance,
are you available for full-time work?
Yes
No

When will you be available to start? (mm-dd-yyyy)

Are you legally eligible for
employment in the U.S.?
Yes
No

Do you have any relatives who currently work for MWAFCU?
Yes
No

Social Security Number *

Other special training skills (Languages, Machine Operation, etc.)

Hours Preferred

Email Address

Referred By:

WorkOne

Website

Newspaper

Other

Job 1

Member

Employee

Education

Name and Location of School

Course of Study

No. of Years Completed

Did You Graduate?

Degree/Diploma

College

Yes

No

High School *

Yes

No

Employment

Please give an accurate, complete full-time and part-time employment record even if you submit a resume with similar information. Start with your most recent employer.

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

Company Name

Telephone Number

Address

Employed (Month and Year (mm-yyyy))

Start

To

Name of Supervisor

Weekly Pay

Start

Last

State Job Title and Describe Your Work

Reason for Leaving (If Still Employed by this Employer, Enter Still Employed)

We may contact the employers listed above unless you indicate those you do not want us to contact.

Employer

Reason

Military

Did you serve in the U.S. Armed Forces?

Yes

No

If yes, what branch?

Other Info

Describe any training received relevant to the position for which you are applying.

Membership in professional or civic organizations

Resume

Open your resume in Word, WordPerfect, etc., highlight the entire resume, press ctrl+c or right click and copy. Return to this screen, click into resume area and press ctrl+v or right click paste. Edit the resume as needed.

People Facts Employment Screening Services* Entire form needs to be completed!

Report Request

Date

Time

ESS Specialist: Team #1/Sheri Coulter

Customer Service#: 85ES70079

MidWest America FCU

Person Ordering Report:

Applicant Information: (Please print all information)

Last Name

First

Middle Initial Suffix

*Maiden

Current address:

Street

City

State
Zip

Previous address:

Street

City

State
Zip

Social Security No:

Male

Female

Driver's License No:

State:

Applicant Authorization

Without reservation, I authorize this employer or any party or agency contacted by this employer to procure my consumerreport and/or to obtain or furnish information concerning my credit, criminal, motor vehicle, and other history. I understandthat inquires may be made to various federal and state agencies, employers, references, acquaintances, and others seekinginformation as to my personal characteristics, credit worthiness, employment status, general reputation, and mode of living.

FCRA Disclosure

This is to inform you that as part of processing your application, a consumer report may be obtained for employment purposes.Please read and or print "A Summary of your Rights Under the Fair Credit Reporting Act" shown above.

My electronic signature must include my full name and last 4 digits of my social security number. I acknowledge I have read all the information in this disclosure.

Signature:

Last 4 of SSN:

Today's Date:

*This information is requested by CBC Employment Screening Services solely for purposes of ensuring accurate retrieval of records. This information must be filled out and signed in order for the application to be processed.

Release for Employment / Educational Reference Request* Entire form needs to be completed!

Please print and read the information below.

The information provided in this application for employment is true, correct, and complete. If employed, any misstatement or omission of fact on the application may result in dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

I authorize you to engage an investigative consumer reporting agency to report on my credit and personal history. If a report is obtained, you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.

Have you ever been convicted of a criminal offense that has not been expunged by a court?*

Yes

No

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case.
(Note: No applicant will be denied employment solely on the grounds of conviction of criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

My electronic signature must include my full name and last 4 digits of my social security number. I acknowledge I have read and printed all the information above.

Signature: *

Last 4 of SSN:

Date:

Prospective employees will receive consideration without discrimination because of race, religion, color, sex, age, national origin, disability, or veteran status.

Thank you for completing our online application and reading the attached "Equal Employment Opportunity Is The Law" and "A Summary of Your Rights Under the Fair Credit Reporting Act". Additional information you would like to include with your online application may be faxed to 260-373-2796 or emailed to training@mwafcu.org.